Colposcopy

Colposcopy is an examination that uses a special instrument called a colposcope to look at any ‘abnormal’ or precancerous cells which you may have in the neck of your womb (cervix).

You’ll meet the doctor or specialist nurse carrying out your examination to discuss your care. It may differ from what’s described here as it’ll be designed to meet your individual needs.

When would I need to have a colposcopy?

If you’re a woman including and between the ages of 25 and 64, you’ll be offered cervical screening to check for any ‘abnormal’ or precancerous cells in your cervix. These cells aren’t cancerous, but in some women can develop into cancer later on. If you have abnormal cells, you may need to have a colposcopy so that your doctor or specialist nurse can look at your cervix in more detail.

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If you have cells that are thought to have either borderline (very slight) changes or be ‘low grade’ (ie they show mild changes), the cells will be tested for the human papillomavirus (HPV). They’ll be tested because HPV is known to cause cervical cancer. If you have the virus, you’ll need to have a colposcopy – if not, you won’t and can go back to routine screening.

If you have abnormal cells that are thought to be high grade (with either moderate or severe changes), you’ll have a colposcopy without being tested for HPV first.

It’s rare, but your doctor or nurse may notice that your cervix looks abnormal during screening. If this happens, you’ll need to have a colposcopy to investigate this.

If you have symptoms that could mean you have cervical cancer, your GP will refer you to a gynaecologist (a doctor who specialises in women’s reproductive health). Depending on what they find, you may be referred for a colposcopy. Symptoms that could mean you have cervical cancer include:

bleeding in between your periods, or after sex

vaginal discharge that is stained with blood

pain in your pelvis

These symptoms can be caused by things other than cervical cancer, but If you have them contact your GP.

What happens before a colposcopy?

Before a colposcopy, your colposcopist (a doctor or specialist nurse, trained in colposcopy) will explain your cervical cytology, or ‘smear’ results to you. They’ll also discuss your general health and wellbeing and explain the examination to you. You’ll need to give your consent for the colposcopy to go ahead, so it's important that you understand what’s involved and ask any question you may have before the examination.

What happens during a colposcopy?

Colposcopy takes about 20 minutes and is usually done in a colposcopy clinic as an out-patient procedure. This means you have the examination and go home the same day.

Your colposcopist (a doctor or specialist nurse, trained in colposcopy) will ask you to lie on your back on a special couch with your feet drawn up, and your knees apart and bent. There may be leg or pedal rests to support your legs or feet.

Your colposcopist will use a piece of equipment called a speculum to hold open your vagina. They’ll then put special solutions on the surface of your cervix to show up any abnormal cells more clearly.

Your colpocopist uses a colposcope (a special magnifying instrument that has a light attached to it) to look at the cells on your cervix. The colposcope will stay outside your body the whole time.

During the examination, your colposcopist may take a biopsy (small piece of tissue) from your cervix to send to the laboratory for testing. They may put a special liquid on to the biopsied area, which acts like a bandage. The biopsy may be uncomfortable, but will only last for a few seconds. If you’re concerned, talk to your colposcopist about this.

From your biopsy, your doctor will learn if you have any precancerous cell changes, or cervical cancer.

Will I need treatment after my colposcopy?

If you have abnormal or precancerous cells, your doctor may offer you treatment to remove them. This will depend on how abnormal your cells are and how far down into your cervix they go. If you need treatment, your doctor will be able to advise which option is best for you.

LLETZ (large loop excision of the transformation zone), is the most common treatment used in the UK. LLETZ uses a loop with an electric current that passes through it, to remove the abnormal cells from your cervix. Other treatments include:

Cryotherapy – this is where abnormal cells are frozen and destroyed

Laser treatment – this involves using a laser to cut out abnormal cells or destroy them

Cold coagulation – a piece of surgical equipment that creates heat, is used to destroy any abnormal cells

Cone biopsy

A cone biopsy is a procedure to remove a cone-shaped wedge from the neck of your womb (cervix). Cone biopsies aren’t that common anymore. But if you have early cervical cancer, you may have a cone biopsy to treat it. You may also have a cone biopsy to remove abnormal cells that cannot be seen or sampled during colposcopy – this is because they go too far up into your cervix.

Unlike the other treatments, cone biopsy is done under general rather than local anaesthetic. If you have a cone biopsy, you may have period-like pains for around 24–48 hours after the procedure.

Will I be treated during my colposcopy appointment?

If you need treatment, it’s possible that your doctor will remove any abnormal cells during your colposcopy appointment. This is called a ’see-and-treat’ appointment. The clinic should tell you about this option before you come in for your appointment. It’s your decision to go ahead with a ‘see-and-treat’ appointment. Talk to your doctor if you’re unsure about anything.

If you need treatment and don’t have a ‘see-and-treat’ appointment, your doctor will arrange for you to have any abnormal cells removed at a second appointment.

Are there side-effects?

Side-effects are the unwanted but mostly temporary effects you may get after having an examination or procedure.

If your doctor or specialist nurse takes a biopsy during your colposcopy, you may have some mild bleeding from your vagina afterwards. You may also have a brown or black discharge from your vagina, which looks like coffee grounds, if your doctor uses a special liquid-type bandage to seal the biopsy area. These side-effects usually only last for a few days, but you may need to wear a sanitary towel during this time.

Could there be complications?

Complications are problems that occur during or after an examination or procedure. They rarely happen at colposcopy, but contact your colposcopy clinic for advice if you have any of the following symptoms:

pain in your lower abdomen (tummy)

heavy bleeding, or bleeding for more than seven days from your vagina

vaginal discharge that smells foul

a fever (high temperature)

What happens after a colposcopy?

You should feel fine straight after your procedure and can go home when you feel ready.

If you’ve had a biopsy and there’s some light bleeding, don’t have sex, use tampons or medication for your vagina until your bleeding has stopped. If you’ve had treatment, you should also avoid swimming for a couple of weeks. You should be able to drive and can go back to doing light exercise and other daily activities as normal.

You should find out about your results between four and eight weeks after your procedure.

If you’re pregnant, you can safely have a colposcopy. But if you know or think you could be pregnant, it’s important to let your doctor or specialist nurse know about this before you go for your appointment.

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Adjunctive colposcopy technologies for examination of the uterine cervix - DySIS and the Niris imaging system. National Institute for Health and Care Excellence (NICE), published August 2012. www.nice.org.uk

Colposcopy (beyond the basics). UpToDate. www.uptodate.com, last updates January 2014

About cervical screening. The British Society for Colposcopy and Cervical pathology. www.bsccp.org.uk, accessed June 2016

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